Healthy Lives, Healthy People Government’s vision for an improved public health system

1. Healthy Lives, Healthy PeopleGovernment’s vision for an improved public health system Public Health Policy & Strategy Unit July 12

2. The challenge: what we are facing and the rationale for change We face significant challenges to public health … • England has one of the highest rates of obesity in the developed world. • Two thirds of adults are overweight or obese, a leading cause of type 2 diabetes and heart disease • In 2008-10, the gap between areas with the highest and lowest life expectancy was around 12 years • Smoking claims over 80,000 lives a year. • 1.6 million people are dependent on alcohol. • Over half a million new sexually transmitted infections were diagnosed in 2010 • Major health threats persist, ranging from risk of new pandemics to the potential impact of terrorist incidents. … with significant costs to health and to the economy • Drug related crime costs £13.9bn per year • Smoking costs the NHS £2.7bn a year • Obesity costs the NHS £4.2bn a year • Dementia costs the UK £17bn a year • Sexual health treatment costs NHS £1.2bn a year

3. The response Health & Social Care Act 2012 makes provision for wholesale system change across health and social care NHS reform Refocusing on public health and prevention Localism Focusing on outcomes not targets

4. The new Public Health System will build on existing success Vision / Outcomes How do we see the future? • Focused on outcomes: improve and protect health and wellbeing for all the people of England and reduce health inequalities • We will have succeeded if, as a nation, we are living longer, and in better health; and if the gap in health between rich and poor is reducing. • Improving outcomes for all at all stages of the life-course • We will improve and protect health and wellbeing – through: • Empowering local leadership and encourage wide responsibility across society to improve health and wellbeing, and tackle the wider factors that influence it • Strengthening self-esteem, confidence and personal responsibility • Positively promoting healthier behaviours and lifestyles • Adapting environments to make healthy choices easier • Protecting the public from health threats – with a strong nationally integrated system that offers expert advice to the NHS, local government and the public Mission What does the PH system have to do?

5. The New Public Health System The new delivery structure: an integrated whole system approach • Government • DH responsible to parliament, with clear line of sight through system • Cabinet sub-committee and significant contribution from across departments to improve health outcomes • CMO to continue to provide independent advice to Government • Local authorities • New public health functions integrated into their wider role, helping to tackle the wider social and economic determinants of health. • Leading for improving health and coordinating locally for protecting health • Promoting population health and wellbeing • Public Health England • New, integrated national body • Strengthened health protection systems • Supporting the whole system through expertise, evidence and intelligence • NHS • Delivering health care and tackling inequalities • Making every contact count • Specific public health interventions, such as cancer screening

6. Accountable and transparent

7. Focused on outcomes Sets out shared priorities for public health Focuses on outcomes not targets There is alignment & integration across public health, the NHS and social care Takes a life-course approach Designed to address the causes of the causes of ill health The intention is to incentivise local progress on some indicators A new Public Health Outcomes Framework that;

8. Infant mortality • Tooth decay in children aged 5 • Mortality from causes considered • preventable • Mortality from all cardiovascular diseases (including heart disease and stroke) • Mortality from cancer • Mortality from liver disease • Mortality from respiratory diseases • Mortality from communicable diseases (Placeholder) • Excess under 75 mortality in adults with serious mental illness (Placeholder) • Suicide • Emergency readmissions within 30 days of discharge from hospital (placeholder) • Preventable sight loss • Health-related quality of life for older people (Placeholder) • Hip fractures in over 65s • Excess winter deaths • Dementia and its impacts (Placeholder) Healthcare public health and preventing premature mortality Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities Overview of outcomes and indicators At a glance - Public Health Outcomes Framework Indicators • Air pollution • Chlamydia diagnoses (15-24 year • olds) • Population vaccination coverage • People presenting with HIV at a late stage of infection • Treatment completion for TB • Public sector organisations with board approved sustainable development management plans • Comprehensive, agreed inter-agency plans for responding to public health incidents (Placeholder) Objective 4 Health protection The population’s health is protected from major incidents and other threats, whilst reducing health inequalities Indicators • Low birth weight of term babies • Breastfeeding • Smoking status at time of delivery • Under 18 conceptions • Child development at 2 – 2.5 years (Placeholder) • Excess weight in 4-5 and 10-11 year olds • Hospital admissions caused by unintentional and deliberate injuries in under 18s • Emotional well-being of looked after children (Placeholder) • Smoking prevalence – 15 year olds (Placeholder) • Hospital admissions as a result of self-harm • Diet (Placeholder) • Excess weight in adults • Proportion of physically active and inactive adults • Smoking prevalence – adults (over 18s) • Successful completion of drug treatment • People entering prison with substance dependence issues who are previously not known to community treatment • Recorded diabetes • Alcohol-related admissions to hospital • Cancer diagnosed at stage 1 and 2 (Placeholder) • Cancer screening coverage • Access to non-cancer screening programmes • Take up of the NHS Health Check programme – by those eligible • Self-reported well-being • Falls and fall injuries in the over 65s Objective 3 Health improvement People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities • Children in poverty • School readiness (Placeholder) • Pupil absence • First time entrants to the youth justice system • 16-18 year olds not in education, employment or training • People with mental illness and or disability in settled accommodation • People in prison who have a mental illness or significant mental illness (Placeholder) • Employment for those with a long-term health condition including those with a learning difficulty / disability or mental illness • Sickness absence rate • Killed and seriously injured casualties on England’s roads • Domestic abuse (Placeholder) • Violent crime (including sexual violence) (Placeholder) • Re-offending • The percentage of the population affected by noise (Placeholder) • Statutory homelessness • Utilisation of green space for exercise / health reasons • Fuel poverty • Social connectedness (Placeholder) • Older people’s perception of community safety (Placeholder) Indicators Objective 2 • Outcome 1) Increased healthy life expectancy, i.e. taking account of the health quality as well as the length of life • Outcome 2) Reduced differences in life expectancy and healthy life expectancy between communities (through greater improvements in more disadvantaged communities) VISION To improve and protect the nation’s health and wellbeing and improve the health of the poorest fastest Improving the wider determinants of health Improvements against wider factors which affect health and wellbeing and health inequalities Outcome measures Indicators Objective 1

9. With a ring-fenced resource A ring-fenced budget for public health at national and local levels Estimated baseline spend for public health = £5.2 billion Of this we estimate approximately: £2.2 billion will go to local authorities £2.2 billion will go to the NHS CB £800 million will go to PHE Incentives for improvements To reward local areas that make progress against key outcomes That do not create additional burden or perverse incentives Policy to be developed in partnership with local government Actual grants announced for 2013/14 in late 2012

10. The role of the NHS CB The NHS CB will be responsible for delivering key public health services. These are: Immunisation services Cancer screening services Non-cancer screening services Children’s public health services for 0-5 year olds (until 2015) Child Health Information Systems (CHIS) Public health services for those in custody settings Sexual Assault Referral Centres The details of this will be set out in an agreement between DH and the NHS CB

11. With national expertise – The role of Public Health England • PHE support to national bodies • Advising Government on the delivery of its policy and strategy for public health, including content of mandate and 7A • Publishing performance against the PH Outcomes Framework • Supporting DAs on UK wide issues (including chemical hazards and radiological protection) • Supporting Science and Research to develop and improve the PH evidence base • Development of the intelligence and analysis to support advances in PH delivery • Learning from and contributing to international experience and research. • Contributing expert resource to public health emergencies elsewhere in the world DH and OGDs Devolved Administrations Science and Research International partners • PHE’s support to the local PH delivery system • Supporting the development of evidence based improvement initiatives through: • Provision of Data, Analysis, Intelligence, Evidence and Expertise • Identification, cataloguing and coordination of best practice • Professional support for the PH workforce (incl appointments and professional accountability) • Nationwide PH improvement campaigns including behavioural science and insight • National delivery of health protection including expertise and co-ordination for incidents • Publication of local PH outcomes Local Authorities CCGs/NHS CB PHE (Local)

12. An effective local delivery system in improving and protecting health and wellbeing RATIONALE LOCAL ROLE • Local Authorities will: • Have a duty to improve health • Bring together holistic approach to health and wellbeing across full range of their responsibilities • Receive ring-fenced PH budget • Lead commissioning of public health services (health improvement, drugs, sexual health) • DPH has specific functions to: • Bringtogether the local PH system • Deliver LA functions • Assure health protection plans • Assure vac and imms and screening • Provide “core offer” to NHS • Produce DPH report • Advise HWBB LAs will take the lead role in PH, commissioning majority of services and assuring and coordinating through DPH and HWBB Local Authorities • NHS will continue to commission PH services where: • within GPC contract • integral part of pathway • 0-5 services and Health Visitors CCGs/NHS CB PHE will provide the local health protection service, linking to resilient national service that links to scarce expertise, nationwide intelligence and national leadership for serious incidents PHE (Local) • CCGs and NHS CB will • Commission healthcare • Commission specific PH services (eg QoF, Immunisations, Military and Prison health) • Coordinates local strategy through: • JSNAs • Joint health and wellbeing strategy • Review of commissioning plans • Receives and reviews PHE’s programme for its locality Health & Wellbeing Board • PHE local units will be part of local delivery system: • Providing health protection service and expert advice • Specialist EPRR function

13. An effective local delivery system in improving and protecting health and wellbeing RATIONALE LOCAL ROLE • Local Authorities will: • Have a duty to improve health • Bring together holistic approach to health and wellbeing across full range of their responsibilities • Receive ring-fenced PH budget • Lead commissioning of public health services (health improvement, drugs, sexual health) • DPH has specific functions to bring together the local PH system: • Deliver LA functions • Assure health protection plans • Assure vac and imms and screening • Provide “core offer” to NHS • Produce DPH report • Advise HWBB LAs will take the lead role in PH, commissioning majority of services and assuring and coordinating through DPH and HWBB Local Authorities • NHS will continue to commission PH services where: • within GPC contract • integral part of pathway • 0-5 services and Health Visitors CCGs/NHS CB PHE will provide the local health protection service, linking to resilient national service that links to scarce expertise, nationwide intelligence and national leadership for serious incidents PHE (Local) • CCGs and NHS CB will • Commission healthcare • Commission specific PH services (eg QoF, Immunisations, Military and Prison health) • Coordinates local strategy through: • JSNAs • Joint health and wellbeing strategy • Review of commissioning plans • Receives and reviews PHE’s programme for its locality Health & Wellbeing Board • PHE local units will be part of local delivery system: • Providing health protection service and expert advice • Specialist EPRR function

14. An effective local delivery system in improving and protecting health and wellbeing RATIONALE LOCAL ROLE • Local Authorities will: • Have a duty to improve health • Bring together holistic approach to health and wellbeing across full range of their responsibilities • Receive ring-fenced PH budget • Lead commissioning of public health services (health improvement, drugs, sexual health) • DPH has specific functions to bring together the local PH system: • Deliver LA functions • Assure health protection plans • Assure vac and imms and screening • Provide “core offer” to NHS • Produce DPH report • Advise HWBB LAs will take the lead role in PH, commissioning majority of services and assuring and coordinating through DPH and HWBB Local Authorities • NHS will continue to commission PH services where: • within GPC contract • integral part of pathway • 0-5 services and Health Visitors CCGs/NHS CB PHE will provide the local health protection service, linking to resilient national service that links to scarce expertise, nationwide intelligence and national leadership for serious incidents PHE (Local) • CCGs and NHS CB will • Commission healthcare • Commission specific PH services (eg QoF, Immunisations, Military and Prison health) • Coordinates local strategy through: • JSNAs • Joint health and wellbeing strategy • Review of commissioning plans • Receives and reviews PHE’s programme for its locality Health & Wellbeing Board • PHE local units will be part of local delivery system: • Providing health protection service and expert advice • Specialist EPRR function

15. An effective local delivery system in improving and protecting health and wellbeing RATIONALE LOCAL ROLE • Local Authorities will: • Have a duty to improve health • Bring together holistic approach to health and wellbeing across full range of their responsibilities • Receive ring-fenced PH budget • Lead commissioning of public health services (health improvement, drugs, sexual health) • DPH has specific functions to bring together the local PH system: • Deliver LA functions • Assure health protection plans • Assure vac and imms and screening • Provide “core offer” to NHS • Produce DPH report • Advise HWBB LAs will take the lead role in PH, commissioning majority of services and assuring and coordinating through DPH and HWBB Local Authorities • NHS will continue to commission PH services where: • within GPC contract • integral part of pathway • 0-5 services and Health Visitors CCGs/NHS CB PHE will provide the local health protection service, linking to resilient national service that links to scarce expertise, nationwide intelligence and national leadership for serious incidents PHE (Local) • CCGs and NHS CB will • Commission healthcare • Commission specific PH services (eg QoF, Immunisations, Military and Prison health) • Coordinates local strategy through: • JSNAs • Joint health and wellbeing strategy • Review of commissioning plans • Receives and reviews PHE’s programme for its locality Health & Wellbeing Board • PHE local units will be part of local delivery system: • Providing health protection service and expert advice • Specialist EPRR function

16. We have completed the broad policy design for the new system Policy Updates issued in December set out the broad design of the new PH system and roles and responsibilities for the Bodies 1 Updates issued as a short, CE focused narrative, with linked factsheets for details. Well received for both content and ease of communication. Covered role and function of PHE and local authorities, established commissioning responsibilities PH Outcomes Framework published in January setting out key outcomes for the public health system 2 Baseline public health estimates for public health system published 3 Key issue for LAs. Publication critical first step. But significant concern over variation and future allocation policy Next step is to engage on ACRA formula and implications Update on Public Health Funding published on 14 June 4 The overarching HR framework for the transition programme is in place HR Concordat and LGA Guidance Awaiting future policy on pensions Building a People transition Policy for PHE Direction for PHE terms and conditions established – negotiations due to conclude in June

17. Implementation activity is underway PCTs required to complete plans for the transfer of PH to LAs by 31 March 2012 as part of the NHS planning round 1 Initial plans received from PCTs. Robust processes in place with Cluster SHAs to assure progress. Final plans required by 31 March to cover the transfer of responsibilities and staff to Local Authorities Almost every local area has set up their shadow Health and Wellbeing Board, of which public health is part. Appointment of PHE CE completed 2 PHE Transition Team progressing design and transition process for PHE.

18. Next steps Enabling legislation on; Arrangements for charging arrangements for LAs London Health & Wellbeing Board Mandatory functions for LAs The role of the DPH in emergency planning and health protection Final advice from ACRA on LA financial allocations and formula for the reward element of the health premium

19. Public health system updates The new public health system factsheets are available at http://healthandcare.dh.gov.uk/publichealth Sign-up to our regular Transforming Public Health bulletin http://phbulletin.dh.gov.uk/ Contact the DH Public Health England transition team PublicHealthEngagement@dh.gsi.gov.uk Contact the DH Public Health Policy and Strategy Unit publichealthpolicyandstrategy@dh.gsi.gov.uk